Defining Diabetic Complications: A Comprehensive Approach

Macrovascular complications are composed of cardiovascular disease, cerebrovascular disease, and peripheral arterial occlusive disease (PAOD); whereas microvascular complications comprise neuropathy, nephropathy, and retinopathy [1 (link), 2 (link)]. In this study, patients with any one of the listed conditions including coronary heart disease, myocardial ischemia and/or infarction, angina, congestive heart failure, arrhythmia, and a history of percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG) were referred to have cardiovascular disease. The cerebrovascular disease is defined as a group of diseases including transient ischemic attack (TIA), ischemic stroke, and hemorrhagic stroke. PAOD is defined as a composite of following status, such as having symptom of intermittent claudication, abnormal foot assessment with reduced or absent pulse over dorsalis pedis artery and/or posterior tibial artery, and a history of percutaneous transluminal angioplasty (PTA), peripheral artery bypass surgery, or amputation. Moreover, diabetic polyneuropathy comprises patients who had neurologic symptoms or aberrant neurologic physical examinations such as decrease/loss of vibratory or pinprick sensation tested by hemi-quantified tuning fork and single-stranded nylon, respectively, on either foot. Patients with diabetic retinopathy are defined as those who had one of the following conditions including macular degeneration, non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), blindness, or receiving laser therapy of retina in the past. Estimated glomerular filtration rate (eGFR), expressed in ml/min/1.73 m², was calculated using the equation from Modification of Diet in Renal Disease (MDRD) [22 (link)]. Finally, diabetic kidney disease (DKD) in this study was defined as eGFR < 60 ml/min/1.73 m² or albuminuria defined as a spot urine albumin to creatinine ratio (UACR) ≥ 30 mg/g.